Uso não prescrito de metilfenidato e desempenho acadêmico de estudantes de medicina / Non-prescribed use of methylphenidate and academic performance of medical students / El uso no prescrito de metilfenidato y el rendimiento académico de estudiantes de medicina

O metilfenidato é um fármaco indicado no tratamento do transtorno de déficit de atenção e hiperatividade (TDAH) e da narcolepsia. Atua no sistema nervoso central inibindo a recaptação de dopamina e noradrenalina, o que provoca um efeito psicoestimulante. Estudos anteriores demonstraram um aumento no consumo da droga por indivíduos saudáveis que buscam aprimoramento cognitivo. O objetivo deste estudo foi investigar a relação entre o uso não prescrito de metilfenidato e o desempenho acadêmico de estudantes de medicina de uma universidade do sul de Santa Catarina. Trata-se de uma pesquisa descritiva de caráter quantitativo. Participaram da pesquisa 243 acadêmicos do segundo ao oitavo semestre do curso de medicina; os dados foram coletados por meio de um questionário e analisados com ajuda do software SPSS versão 21.0. A prevalência de uso não prescrito do metilfenidato foi de 2,9%, enquanto 17,3% dos pesquisados afirmaram já ter utilizado o medicamento alguma vez na vida. As motivações para consumo mais citadas foram melhorar o desempenho cognitivo (10%) e ficar acordado por mais tempo (4,1%), e a forma de obtenção mais comum foi por meio de amigos (56,5%). O psicoestimulante não apresentou efeitos de aprimoramento cognitivo, uma vez que participantes que nunca utilizaram o fármaco apresentaram um desempenho acadêmico superior (8,80) se comparados àqueles que usam (7,92) ou já usaram (8,01). Os resultados corroboram a hipótese de efeito relacionado a sensações de bem-estar em pessoas saudáveis, o que torna preocupante a injustificada exposição aos efeitos adversos da droga. Ressalta-se a necessidade de ações que visem à promoção de saúde mental aos universitários.(AU)

Methylphenidate is a drug indicated for the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. It acts on the central nervous system by inhibiting dopamine and norepinephrine reuptake, causing a psychostimulant effect. Previous studies have shown an increase in drug use by healthy individuals seeking cognitive enhancement. This study aimed to investigate the relationship between non-prescribed methylphenidate use and academic performance of medical students of a university in southern Santa Catarina. It is quantitative descriptive study. A total of 243 students from the second to the eighth semester of the medicine school participated in the research; data were collected by using a questionnaire and analyzed with the software SPSS Version 21.0. The prevalence of non-prescribed methylphenidate use was 2.9% and 17.3% of respondents said they had used the drug once in their lifetime. The most cited motivations for consumption were improving cognitive performance (10%) and staying awake longer (4.1%), with the most common way of obtention being through friends (56.5%). The psychostimulant had no cognitive enhancement effects since participants who never used the drug had a higher academic performance (8.80) compared with those who use (7.92) or have used it (8.01). The results corroborate the hypothesis of an effect related to feelings of well-being in healthy people, thus making the unjustified exposure to the adverse effects of the drug concerning. We emphasize the need for actions aimed at promoting mental health to university students.(AU)

El metilfenidato es un medicamento indicado para el tratamiento del trastorno por déficit de atención e hiperactividad (TDAH) y de la narcolepsia. Actúa sobre el sistema nervioso central al inhibir la reabsorción de dopamina y norepinefrina, causando un efecto psicoestimulante. Estudios anteriores han demostrado un aumento del consumo de este medicamento por personas sanas que buscan una mejora cognitiva. El objetivo de este estudio fue investigar la relación entre el uso no prescrito de metilfenidato y el rendimiento académico de los estudiantes de medicina de una universidad en el sur de Santa Catarina (Brasil). Se trató de una investigación cuantitativa descriptiva. Participaron en la investigación 243 estudiantes del segundo al octavo semestre del curso de medicina; los datos se recolectaron mediante un cuestionario y se analizaron con la ayuda del software SPSS, versión 21.0. La prevalencia del uso no prescrito de metilfenidato fue del 2,9%, y el 17,3% de los encuestados dijeron que habían usado el medicamento en algún momento de sus vidas. Las motivaciones de consumo más citadas fueron: mejorar el rendimiento cognitivo (10%) y permanecer despierto por más tiempo (4,1%), y la forma más común de obtenerlo fue con los amigos (56,5%). El psicoestimulante no tuvo ningún efecto de mejora cognitiva, ya que los participantes que nunca lo usaron tuvieron un rendimiento académico superior (8,80) en comparación con aquellos que lo usan (7,92) o lo han usado (8,01). Los resultados corroboraron la hipótesis de un efecto relacionado con los sentimientos de bienestar en personas sanas, lo que provoca una exposición injustificada a los efectos adversos de este fármaco. Se enfatiza la necesidad de acciones dirigidas a promover la salud mental de los estudiantes universitarios.(AU)

Perceptual-motor ability assessment in people with atypical development / Avaliação da maturidade perceptomotora em pessoas com desenvolvimento atípico / Evaluación de la madurez percepto-motriz en personas con desarrollo atípico

The assessment of perceptual-motor maturity has been investigated, and evidence indicates its relevance in the prediction of academic performance, which justifies the relevance of its investigation. This study investigated the psychometric qualities of a screening version of the Bender-Gradual Scoring System (B-SPG in Portuguese) in 273 individuals aged between six and 24 (M = 13.27, SD = 3.63), 166 (60, 8%) males, who were diagnosed with intellectual disabilities. The results of the exploratory factor analysis and regression analysis were satisfactory and demonstrated that it is possible to use only three figures to carry out the evaluation, which facilitates the psychologist's work. The accuracy of the instrument was also estimated, and the results showed adequate indexes. It is concluded that the screening version of the B-SPG proves to be an adequate measure for children with atypical development. However, other studies should be performed.

A avaliação da maturidade perceptomotora tem sido investigada, e evidências indicam sua relevância na predição do desempenho acadêmico, o que justifica a pertinência de sua investigação. O presente estudo investigou as qualidades psicométricas de uma versão de rastreio do Bender-Sistema de Pontuação Gradual (B-SPG) em 273 indivíduos com idades variando de 6 a 24 anos (M = 13,27, DP = 3,63), sendo 166 (60,8%) do sexo masculino, que tinham o diagnóstico de deficiência intelectual. Os resultados da análise fatorial exploratória e da análise de regressão foram satisfatórios e revelaram que é possível utilizar apenas três figuras para realizar a avaliação, o que facilita o trabalho do psicólogo. A precisão também foi estimada, e os resultados mostraram índices adequados. Conclui-se que a versão de rastreio do B-SPG se mostra uma medida adequada para crianças com desenvolvimento atípico, no entanto outros estudos devem ser realizados.

La evaluación del desarrollo percepto-motriz ha sido investigada y existen evidencias de su relevancia para predecir el desempeño académico, lo cual justifica la realización del trabajo. Este estudio investigó las cualidades psicométricas de una versión de sondeo del Bender-Sistema de Pontuação Gradual (B-SPG) en 273 individuos con edades entre 6 y 24 años (M = 13,27, DT = 3,63), siendo 166 (60,8%) del sexo masculino, que poseían diagnóstico de deficiencia intelectual. Los resultados del análisis factorial exploratorio y del análisis de regresión fueron satisfactorios, revelando que es posible utilizar apenas tres figuras para realizar la evaluación, lo cual facilitaría el trabajo del psicólogo. La confiabilidad también fue verificada y los resultados mostraron índices adecuados. Se concluye que la versión de sondeo del B-SPG parece ser una medida adecuada para niños con deficiencia intelectual, pero pese a eso, otros estudios deben ser realizados.

Emotional Dysregulation Scale - Adults (EDEA): validity evidence / Escala de Desregulação Emocional - Adultos (EDEA): evidências de validade / Escala de Desregulación Emocional - Adultos (EDEA): evidencias de validez

Emotional self-regulation is necessary at various times in life; however, studies have indicated differences in the way men and women tend to express, contain, or change their emotions. These events are essential to be investigated in psychological instruments, since, when assessing this construct, an item could be endorsed by either sex, resulting in a biased conclusion. With this in mind, this study aimed to analyze the differential item functioning (DIF) of the Emotional Self-Regulation Scale - Adult (EARE-AD) for sadness, concerning the gender variable and the instrument's distribution's response categories. Due to the existence of DIF, neutralized items were prioritized, thus favoring less biased results. Based on this, in a second study, a reduced version of the scale (Emotional Dysregulation Scale - Adults - EDEA) with 15 items was proposed. We searched for validity evidence based on the internal structure for this new version.

A autorregulação emocional é necessária em diversas ocasiões da vida, porém estudos têm indicado diferenças na forma como homens e mulheres tendem a expressar, conter ou mudar suas emoções. É importante investigar essas considerações em instrumentos psicológicos, uma vez que, quando se avalia esse construto, sobretudo no caso de um item ter maior probabilidade de endosso por um ou outro sexo, os resultados podem ser enviesados. Com base nisso, o objetivo deste estudo foi analisar o funcionamento diferencial do item (DIF) da Escala de Autorregulação Emocional - Adulto (EARE-AD) para tristeza, em relação à variável sexo. Além disso, analisaram-se as distribuições das categorias de respostas do instrumento. Mediante a existência de DIF, itens neutralizados foram priorizados, favorecendo assim resultados menos tendenciosos. A partir disso, em um segundo estudo, foi proposta uma versão reduzida da escala (Escala de Desregulação Emocional - Adultos - EDEA) com 15 itens, com vistas a buscar evidências de validade baseadas na estrutura interna para essa nova versão.

La autorregulación emocional es necesaria en varios momentos de la vida, sin embargo, los estudios han indicado diferencias en la forma en que hombres y mujeres tienden a expresar, contener o cambiar sus emociones. Estas informaciones son importantes para ser investigadas en los instrumentos psicológicos, pues al evaluar estos aspectos, cuando es más probable que un ítem sea respaldado en ambos sexos, los resultados pueden estar sesgados. Así, el objetivo de este estudio fue analizar el funcionamiento diferencial del ítem (DIF) de la Escala de Autorregulación Emocional - Adulto (EARE-AD) para la tristeza, en relación con la variable de sexo, además de la distribución de las categorías de respuesta del instrumento. Debido a la existencia de DIF, se priorizaron los ítems neutralizados, lo que favoreció resultados menos sesgados. En base a esto, en un segundo estudio, se propuso una versión reducida de la escala (Escala de Desregulación Emocional - Adultos - EDEA) con 15 ítems, en que se buscó por la evidencia de validez basada en la estructura interna de esta nueva versión.

Equilibrio, cinética y termodinámica de la adsorción del colorante DB-86 sobre carbón activado de la cáscara de yuca / Equilibrium, kinetic and thermodynamic of direct blue 86 dye adsorption on activated carbon obtained from manioc husk

RESUMEN Objetivo. Establecer mediante experimentos por lote la capacidad de remoción, la cinética y termodinámica de adsorción del carbón activado preparado a partir de la cáscara de yuca (Manihot esculenta) en la remoción del colorante azul directo 86. Materiales y métodos. La metodología experimental consistió inicialmente en la preparación del carbón activado por activación química de la cáscara de yuca con H3PO4 y su posterior calcinación a 530°C. En la caracterización se determinaron las propiedades de textura mediante el índice de yodo e índice de azul de metileno, se cuantificaron los grupos funcionales orgánicos ácidos y básicos con el método Boehm, y se realizó el análisis próximo siguiendo las normas ASTM D-2867-70, ASTM D2866 y ASTM D2866-94. En el estudio por lote, el efecto de varios parámetros sobre la capacidad de adsorción fueron evaluados: el pH (2, 4, 8 y 10), la temperatura (25, 30 y 40°C) y la concentración inicial de colorante (20, 40, 60, 80 y 100 mg/L). Tanto las características fisicoquímicas como los ensayos de adsorción del carbón activado preparado a partir de la cáscara de yuca (CAY) fueron comparadas con otro de marca comercial (CAM). Resultados. Los resultados de la caracterización indican que ambos carbones tienen una química de superfície heterogénea, de naturaleza ácida para el CAY y básica para el CAM. La máxima capacidad obtenida fue 6.1 mg/g para el CAY y de 3.7 mg/g para el CAM. Los cálculos termodinámicos indican que la remoción es espontánea y para ambos carbones la cinética se ajusta al modelo de pseudo segundo orden. Conclusiones. El carbón activado obtenido a partir de la cáscara de yuca puede considerarse un adsorbente eficiente en la remoción de colorantes.

ABSTRACT Objective. To establish by means of experimenting by batch the capacity of removal, the kinetics and adsorption thermodynamics of activated carbon prepared from manioc husk (Manihot esculenta) in the removal of direct blue 86 dye. Materials and methods. Firstly, the experimental methodology worked on the preparation of activated carbon by chemical activation of manioc husk with H3PO4 calcined at 530°C. In the characterization the texture properties were determined by means of the blue methylene and iodine indices, the basic and acidic functional groups were quantified by the Boehm method, and the proximate analyses were done following the norms ASTM D2867-70, ASTM D2866 and ASTM D2866-94. During the batch studies, the effect of several parameters over the adsorption capacity was evaluated: pH (2, 4, 8 and 10), temperature (25, 30 and 40°C) and initial concentration of the dye (20, 40, 60, 80 and 100 mg/L). Both physicochemical and adsorption characteristics of the activated carbon from manioc husk (CAY) were compared against those of a commercial brand (CAM). Results. The results of characterization showed that both carbons have a chemistry heterogeneous surface, acidic for CAY and basic for CAM. The maximum capacity obtained was 6.1 mg/g for CAY and 3.7 mg/g for CAM. The thermodynamic calculations showed that the removal was spontaneous. The kinetics for both carbon samples fits a pseudo second-order model. Conclusions. The activated carbon obtained from the manioc husk can be considered an efficient adsorbent for the removal of dyes.

Variáveis morfogênicas e estruturais de sorgo forrageiro implantado com diferentes arranjos populacionais sob pastoreio contínuo / Morphogenetic and structural variables of sorghum implanted with different population arrangements under continuous grazing

O objetivo do estudo foi avaliar os efeitos da utilização de diferentes arranjos populacionais na implantação de sorgo forrageiro nas características morfogênicas e estruturais do pasto. Os tratamentos foram 22 ou 44cm entrelinhas e 12 ou 24kg de sementes ha-1. O método de pastoreio foi contínuo. Foram utilizadas 36 novilhas, com idade e peso corporal médios de 15 meses de 262kg. As variáveis morfogênicas não foram influenciadas significativamente (P>0,05) pelos arranjos populacionais e pelos períodos de avaliação, sendo obtidos taxa de alongamento e senescência foliar de 1,43 e 1,11cm dia-1afilho-1, respectivamente, taxa de aparecimento foliar e intervalo de surgimento de folhas de 0,28 folhas dia-1afilho-1 e 3,81 dias, filocrono e duração de vida foliar de 72,99 e 351,68 graus dia, nessa ordem. As características estruturais do pasto foram influenciadas pelos períodos de avaliação. Do primeiro para o terceiro período de avaliação, foi verificada uma redução de 65,53% no número de folhas em alongamento e de 47,79% no número de folhas vivas.(AU)

The objective of the study was to evaluate the effects of using different population arrangements in the implementation of sorghum in the morphogenetic and structural characteristics of the pasture. The treatments were 22 or 44cm between rows and 12 or 24kg ha-1 of seed. The grazing method was continuous. The sample consisted of 36 heifers with an average age of 15 months and average body weight of 262kg. Morphogenic variables were not significantly influenced (P>0.05) by population arrangements and evaluation periods, elongation rate and leaf senescence of 1.43 and 1.11cm afilho-1 day-1 being obtained, respectively, and leaf appearance rate of leaf appearance leaves the range of 0.28 day-1 and 1afilho 3.81 days, phyllochron and leaf duration of life of 72.99 and 351.68 degree day, in that order. The structural characteristics of the pasture were influenced by evaluation periods. From the first to the third evaluation period, a reduction of 65.53% in the number of leaves in stretching and 47.79% in the number of living leaves was verified.(AU)

Antidiarrheal activity of extracts from Maytenus gonoclada and inhibition of Dengue virus by lupeol

ABSTRACT Diarrhea is an infectious disease caused by bacterial, virus, or protozoan, and dengue is caused by virus, included among the neglected diseases in several underdeveloped and developing countries, with an urgent demand for new drugs. Considering the antidiarrheal potential of species of Maytenus genus, a phytochemical investigation followed by antibacterial activity test with extracts of branches and heartwood and bark of roots from Maytenus gonoclada were conducted. Moreover, due the frequency of isolation of lupeol from Maytenus genus the antiviral activity against Dengue virus and cytotoxicity of lupeol and its complex with β-cyclodextrins were also tested. The results indicated the bioactivity of ethyl acetate extract from branches and ethanol extract from heartwood of roots of M. gonoclada against diarrheagenic bacteria. The lupeol showed potent activity against Dengue virus and low cytotoxicity in LLC-MK2 cells, but its complex with β-cyclodextrin was inactive. Considering the importance of novel and selective antiviral drug candidates the results seem to be promising.

Hospitalizations of children with sickle cell disease in the Brazilian Unified Health System in the state of Minas Gerais / Internações de crianças com doença falciforme no Sistema Único de Saúde no Estado de Minas Gerais

Abstract Objective: To identify and characterize hospital admissions and readmissions in the Brazilian Unified Public Health System (Sistema Único de Saúde [SUS]) in children with sickle cell disease diagnosed by the Minas Gerais Newborn Screening Program between 1999 and 2012. Methods: Hospital Admission Authorizations with the D57 (International Classification of Diseases-10) code in the fields of primary or secondary diagnosis were retrieved from the SUS Databank (1999-2012). There were 2991 hospitalizations for 969 children. Results: 73.2% of children had hemoglobin SS/Sβ0-thalassemia and 48% were girls. The mean age was 4.3 ± 3.2 years, the mean number of hospitalizations, 3.1 ± 3.3, and the hospital length of stay, 5 ± 3.9 days. Hospital readmissions occurred for 16.7% of children; 10% of admissions were associated with readmission within 30 days after discharge; 33% of readmissions occurred within seven days post-discharge. There were 41 deaths, 95% of which were in-hospital. Secondary diagnoses were not recorded in 96% of admissions, making it impossible to know the reason for admission. In 62% of cases, hospitalizations occurred in the child's county of residence. The total number of hospitalizations of children under 14 with sickle cell disease relative to the total of pediatric hospitalizations increased from 0.12% in 1999 to 0.37% in 2012. Conclusions: A high demand for hospital care in children with sickle cell disease was evident. The number of hospitalizations increased from 1999 to 2012, suggesting that the disease has become more "visible." Knowledge of the characteristics of these admissions can help in the planning of care for these children in the SUS.

Resumo Objetivo: Identificar e caracterizar as internações e reinternações hospitalares pelo Sistema Único de Saúde (SUS) de crianças com doença falciforme, diagnosticadas pelo Programa de Triagem Neonatal de Minas Gerais entre 1999 e 2012. Métodos: Extraíram-se do banco de dados do SUS as Autorizações de Internação Hospitalar com o código D57 (Classificação Internacional de Doenças10) nos campos de diagnóstico primário ou secundário (1999-2012). Identificaram-se 969 crianças, total de 2.991 internações. Resultados: Das crianças, 73,2% tinham hemoglobina SS/Sβ0- talassemia e 48% eram meninas. A média foi de 4,3 ± 3,2 anos, a do número de internações, 3,1 ± 3,3 e a do tempo de permanência, 5 ± 3,9 dias. As readmissões hospitalares ocorreram em 16,7% das crianças; 10% das internações se associaram à readmissão em até 30 dias pós-alta; 33% das readmissões ocorreram em até 7 dias pós-alta. Ocorreram 41 óbitos, 95% em ambiente hospitalar. O diagnóstico secundário não foi registrado em 96% das internações, impossibilitou conhecer o motivo da internação. Em 62% dos casos, as internações ocorreram no município de residência da criança. O total de internações de crianças até 14 anos com doença falciforme em relação ao total das internações pediátricas passou de 0,12% em 1999 para 0,37% em 2012. Conclusões: Constatou-se elevada demanda por cuidados hospitalares, cujo aumento relativo entre 1999 e 2012 sugere incremento da "visibilidade" da doença falciforme. O conhecimento das características dessas internações pode contribuir para o planejamento do cuidado na rede assistencial do SUS.

Antimicrobial susceptibility profile of enterotoxigenic and enteropathogenic Escherichia coli isolates obtained from fecal specimens of children with acute diarrhea / Perfil de suscetibilidade a drogas antimicrobianas de amostras de Escherichia coli enterotoxigênica e enteropatogênica isoladas de espécimes fecais de crianças com doença diarreica aguda

ABSTRACT Among the diseases which etiopathogenesis is associated with Escherichia coli, acute diarrhea stands out. Studies on the characterization of the antimicrobial susceptibility profile contribute to the selection of appropriate empirical antimicrobial therapy. In this study, the antimicrobial susceptibility profile of 98 enterotoxigenic E. coli (ETEC) and enteropathogenic E. coli (EPEC) strains isolated from fecal specimens of children with acute diarrhea was evaluated. The resistance rates to ampicillin, sulfamethoxazole/trimethoprim, amoxicillin/clavulanate, and nalidixic acid were high, ranging from 34.7% to 10.2%. The result of this research recommends the use of cefotaxime and ceftriaxone for the empirical treatment of children with acute diarrhea which the etiology suggested is ETEC or EPEC.

RESUMO Entre as doenças cuja etiopatogenia está associada à Escherichia coli, destaca-se a doença diarreica aguda. Estudos que visam à caracterização do perfil de suscetibilidade antimicrobiana contribuem para o delineamento de antibioticoterapia empírica eficaz. Neste estudo, foi avaliado o perfil de suscetibilidade a antimicrobianos de 98 amostras de E. coli enterotoxigênica (ETEC) e E. coli enteropatogênica (EPEC) isoladas de crianças com doença diarreica. As frequências de resistência a ampicilina, sulfametoxazol-trimetoprima, amoxicilina-clavulanato e ácido nalidíxico foram elevadas, variando entre 34,7% e 10,2%. Esta pesquisa recomenda o emprego de cefotaxima e ceftriaxona para o tratamento empírico de crianças com quadro de diarreia cuja etiologia sugerida seja ETEC ou EPEC.

Parâmetros reprodutivos e produtivos em vacas leiteiras de manejo free stall / Productive and reproductive parameters of dairy cows in free stall

Avaliou-se parâmetros reprodutivos e produtivos em vacas da raça Holandês-PB no pós-parto imediato, manejadas em free stall . Utilizou-se 51 vacas entre primíparas e pluríparas. Os valores obtidos foram: escore de condição corporal ao parto 3,47±0,4; intervalos do parto à primeira ovulação 5,89±3,4 semanas; ao primeiro serviço 112,5±57,0 dias; a taxa de gestação ao primeiro serviço foi 43,6% e no período experimental 76,4%, não sendo observada diferença para ordens de parto (P>0,05). A produção de leite acumulada à concepção, produção diária leite até a concepção e produção de leite ajustado para 305 foi respectivamente, 3.335,6±1.488,4; 25,8±5,4 e 7.424,0±1.877,8 litros. Conclui-se que no manejo de Free stall , a detecção de estro, foi o principal fator limitante para alcançar melhor eficiência reprodutiva.

The reproductive and productive parameters in postpartum of 51 primiparous and pluriparous Holstein cows housed in free stall were obtained. The values measured were: body condition score at parturition (3.47±0.4), interval from parturition to first ovulation (5.89±3.4 weeks), interval parturition at first service (112.5±57.0 days), first-service pregnancy rate (43.6%) and during the experimental period (76.4%). No difference was found between parturition order (P>0.05). The accumulated milk production until conception time, daily production until conception time, and adjusted 305-day milk production was respectively 3,335.6±1,488.4; 25.8±5.4 and 7,424.0±1,877.8 liters. In free stall of this study the estrus detection was the most limiting factor to improve the reproductive efficiency.

Unusual remodeling of the hyalinization band in vulval lichen sclerosus by type V collagen and ECM 1 protein

OBJECTIVES: The vulva is the primary site affected in lichen sclerosus, a chronic dermatosis in women that is histologically characterized by a zone of collagen remodeling in the superior dermis. The normal physiological properties of the vulva depend on the assembly of collagen types I (COLI), III (COLIII) and V (COLV), which form heterotypic fibers, and extracellular matrix protein interactions. COLV regulates the heterotypic fiber diameter, and the preservation of its properties is important for maintaining normal tissue architecture and function. In the current work, we analyzed the expression of COLV and its relationship with COLI, COLIII, elastic fibers and extracellular matrix protein 1 in vulvar biopsies from patients with lichen sclerosus. METHODS: Skin biopsies from 21 patients with lichen sclerosus, classified according to Hewitt histological criteria, were studied and compared to clinically normal vulvar tissue (N=21). Morphology, immunohistochemistry, immunofluorescence, 3D reconstruction and morphometric analysis of COLI, COLIII, COLV deposition, elastic fibers and extracellular matrix 1 expression in a zone of collagen remodeling in the superior dermis were performed. RESULTS: A significant decrease of elastic fibers and extracellular matrix 1 protein was present in the hyalinization zone of lichen sclerosus compared to healthy controls. The non-homogeneous distribution of collagen fibers visualized under immunofluorescence in the hyalinization zone of lichen sclerosus and control skin was confirmed by histomorphometry. Lichen sclerosus dermis shows a significant increase of COLI, COLIII and COLV expression compared to the healthy controls. Significant inverse associations were found between elastic fibers and COLV and between COLV and extracellular matrix 1 expression. A direct association was found between elastic fiber content and extracellular matrix 1 expression. Tridimensional reconstruction of the heterotypic fibers ...

Use of digital media for the education of health professionals in the treatment of childhood asthma / Uso de mídia digital na educação de profissionais de saúde para tratamento da asma infantil

OBJECTIVES: Inhalation therapy is the main treatment for asthma and its adequate use has been a factor responsible for disease control; therefore, the aim of the study was to determine whether a digital media tool, which features portability on mobile phones, modifies the assimilation of the inhalation technique. METHODS: A total of 66 professionals working in the health care area with the pediatric population were selected. They were submitted to a pre-test on their knowledge of inhalation therapy. The professionals were randomized into two groups (A and B). Group A received a media application on their mobile phones showing the steps of inhalation therapy, while group B received the same information in written form only. A post-test was applied after 15 days. The results (pre- and post-) were analyzed by two pediatric pulmonologists. RESULTS: Of the 66 professionals, 87.9% were females. Of a total possible score of ten, the mean score obtained in the pre-test was 5.3 ± 3, and in the second test, 7.5 ± 2 (p < 0.000). There were no significant differences when comparing the two groups (p = 0.726). The nurses had the lowest mean scores in the initial test (2.3 ± 2); however, they were the group that learned the most with the intervention, showing similar means to those of other groups in the second test (6.1 ± 3). CONCLUSION: There was significant improvement in knowledge about inhalation therapy in all professional categories using both methods, demonstrating that education, when available to professionals, positively modifies medical practice. .

OBJETIVOS: A inaloterapia representa a principal forma de tratamento da asma e seu uso adequado tem sido fator responsável pelo controle da doença. Desse modo, o objetivo do estudo foi determinar se uma ferramenta de mídia digital, dotada de portabilidade na forma de telefonia móvel, modifica a assimilação da técnica inalatória. MÉTODOS: Foram selecionados 66 profissionais que atuam na área da saúde com população pediátrica e submetidos a um pré-teste sobre seus conhecimentos de inaloterapia. Os profissionais foram randomizados em dois grupos (A e B). O grupo A recebeu em seu telefone móvel um aplicativo de mídia com os passos da inaloterapia, enquanto o grupo B recebeu as mesmas informações apenas de forma escrita. Após 15 dias, fez-se um pós-teste. Os resultados (pré e pós) foram analisados por dois pneumologistas pediátricos. RESULTADOS: Dos 66 profissionais, 87,9% eram do sexo feminino. Num escore total possível de 10, a média das notas obtidas no pré-teste foi de 5,3 ± 3 e as do segundo teste 7,5 ± 2 (p < 0,000). Não houve diferenças significativas na comparação os dois grupos (p = 0,726). Os profissionais de enfermagem apresentaram a menor média nas provas iniciais (2,3 ± 2), porém foi o grupo que aprendeu mais com a intervenção e apresentou média similar aos outros grupos na segunda prova (6,1 ± 3). CONCLUSÃO: Houve melhoria significativa no conhecimento sobre inaloterapia em todas as categorias profissionais com o uso de ambos os métodos. Isso comprovou que a educação, quando oferecida aos profissionais, modifica positivamente a prática médica. .

Assessment and management of pediatric pain based on the opinions of health professionals

The present study characterized the opinions of health professionals about strategies for assessing and managing pediatric pain in a public teaching hospital. The sample consisted of 92 health professionals who worked in pediatric wards, pediatric intensive care, and neonatal intensive care. The sample included 45 doctors, 18 nurses, 16 psychologists, eight physiotherapists, and five occupational therapists. Data were collected through a self-administered questionnaire that included 22 open questions on the following topics: pain assessment, pharmacological management, and non-pharmacological interventions. Each area was analyzed with regard to actions, resources, gaps, and needs. The questionnaire was developed based on the principles of Strategic Planning. Two trained researchers analyzed the thematic content of all of the responses. With regard to actions and resources, 33% of the respondents mentioned the use of instruments for pain assessment, 73% reported that they prescribed pharmacological treatments for symptoms of pain, and 26% reported the use of non-pharmacological interventions for the relief of pain. The professionals predominantly reported a lack of training for pain assessment and management, standardized protocols, and human and material resources. Consequently, 96% of the professionals reported the necessity for educational training and standardized implementation guidelines for pain assessment services. These findings provide a baseline of the health professional's opinions of pain issues, which are essential for implementing and increasing pain assessment and management policies institutionally.

Acid-base balance of dairy cows and its relationship with alcoholic stability and mineral composition of milk / Equilíbrio ácido-base de vacas leiteiras e sua relação com a estabilidade alcoólica e composição mineral do leite

This study aimed to associate the occurrence of acid-base disorders with the alcoholic stability of milk from animals in the field, and to evaluate differences between the mineral composition of milk that was both stable and unstable in alcohol. The sample comprised 96 dairy cows, where the milk and blood of each corresponding animal was collected. The mineral composition of stable and unstable milk in alcohol was different and may be related to acid-base disturbances. The average amount of phosphate was lower in the milk that was unstable in alcohol, while potassium was greater. Frequency of the alcoholically unstable milk cases was higher in the cows with acid-base disturbances. Respiratory alkalosis was the disorder that was most observed.

Esse trabalho teve como objetivo associar a ocorrência de distúrbios ácido-base com a estabilidade alcoólica do leite de animais a campo, bem como avaliar diferenças entre a composição mineral de leites estáveis e instáveis ao álcool. A amostragem compreendeu 96 vacas leiteiras, das quais o leite e o sangue correspondente de cada animal foram coletados. A composição mineral entre leites estáveis e instáveis ao álcool foi diferente e também pode estar relacionada aos distúrbios ácido-básicos. A quantidade média de fosfato foi menor no leite instável ao álcool, enquanto a de potássio foi maior. A frequência de amostras de leite com instabilidade alcoólica foi maior nas vacas com distúrbios ácido-básicos. A alcalose respiratória foi o desequilíbrio mais observado.

Role of α2-adrenoceptors in the lateral parabrachial nucleus in the control of body fluid homeostasis

Central α2-adrenoceptors and the pontine lateral parabrachial nucleus (LPBN) are involved in the control of sodium and water intake. Bilateral injections of moxonidine (α2-adrenergic/imidazoline receptor agonist) or noradrenaline into the LPBN strongly increases 0.3 M NaCl intake induced by a combined treatment of furosemide plus captopril. Injection of moxonidine into the LPBN also increases hypertonic NaCl and water intake and reduces oxytocin secretion, urinary sodium, and water excreted by cell-dehydrated rats, causing a positive sodium and water balance, which suggests that moxonidine injected into the LPBN deactivates mechanisms that restrain body fluid volume expansion. Pretreatment with specific α2-adrenoceptor antagonists injected into the LPBN abolishes the behavioral and renal effects of moxonidine or noradrenaline injected into the same area, suggesting that these effects depend on activation of LPBN α2-adrenoceptors. In fluid-depleted rats, the palatability of sodium is reduced by ingestion of hypertonic NaCl, limiting intake. However, in rats treated with moxonidine injected into the LPBN, the NaCl palatability remains high, even after ingestion of significant amounts of 0.3 M NaCl. The changes in behavioral and renal responses produced by activation of α2-adrenoceptors in the LPBN are probably a consequence of reduction of oxytocin secretion and blockade of inhibitory signals that affect sodium palatability. In this review, a model is proposed to show how activation of α2-adrenoceptors in the LPBN may affect palatability and, consequently, ingestion of sodium as well as renal sodium excretion.

Bender- Sistema de Pontuação Gradual (B-SPG): análise de maturação percepto-motora de crianças / Bender- Gradual Scoring System (B-SPG): analysis of the maturation of visual-motor perception children

Este estudo objetivou investigar o aspecto maturacional da habilidade percepto-motora, avaliada pelo Bender – Sistema de Pontuação Gradual (B-SPG), na relação com idade e escolaridade. Foram feitas análises de variância entre o escore total e a pontuação recebida em cada reprodução das figuras, sendo comparadas de acordo com a idade e o ano escolar. Os participantes foram 361 alunos, de ambos os sexos, entre 6 e 10 anos, a partir de primeiro ao quinto ano do ensino fundamental de escolas públicas e privadas. As pontuações totais obtidas no teste foram diferenciadas significativamente em relação à idade e à escolaridade. Confirmando a proposta do instrumento, foi possível evidenciar que o B-SPG mostrou-se sensível em captar o aspecto maturacional da habilidade percepto-motora.

This study aimed toinvestigate the maturational aspect of visual motor perception ability, assessed by Bender -Gradual Scoring System (B-SPG) in relation to age and educational level. Analyses of variance were made between the total score and the punctuation received on each reproduction of the figures, being compared according to age and educational level. Participants were 361 students, of both genders, between 6 and 10 years, from 1st to 5th years of primary education from public and private schools. The total scores obtained in the test differed significantly in relation to age and educational level. Confirming the proposal of instrument, it became clear that the B-GSP proved to be sensitive to capture the maturational aspect of visual motor perception ability.

Tratamento de pigmentação melânica gengival pela técnica de abrasão epitelial / Treatment of gingival melanin pigmentation by epithelial abrasion technique

A pigmentação gengival é causada por uma deposição excessiva de melanina, principalmente na camada basal do epitélio, prejudicando muitas vezes a estética do sorriso. O objetivo é apresentar um caso clínico de pigmentação melânica gengival tratado pela técnica de gengivoplastia por abrasão epitelial. Paciente de 26 anos, melanoderma, procurou atendimento odontológico com queixa de manchas escurecidas na gengiva. Ao exame clínico pode ser observado pigmentação gengival que abrangia toda a faixa de gengiva ceratinizada na região vestibular do arco superior e inferior. O tratamento indicado foi a técnica de gengivoplastia por abrasão epitelial com instrumentos rotatórios. No acompanhamento pós-operatório de 15 diasfoi possível observar a completa cicatrização e harmonia da coloraçãodo tecido gengival. Após dois anos, pequenas áreas de repigmentação foram identificadas, porém, não interferindo no resultado estético do tratamento. A técnica proposta mostrou-se efetiva na remoção do pigmento melânico, resultando em uma estética satisfatória.

Gingival pigmentation is caused by excessive deposition of melanin, mainly in the epithelial basal layer, often damaging the smile aesthetics. The objective of this study is to present a case of gingival melanin pigmentation treated by gingivoplasty by epithelial abrasion technique. A patient of 26 years old, female, searched for dental care complaint darkened patches on the gums. On clinical examination, gingival pigmentation covering the full range of keratinized gingiva on the buccal region of the upper and lower arch can be seen. The treatment was the gingivoplasty by epithelial abrasion technique with rotary instruments. Postoperative follow-up of 15 days was possible to observe the complete healing and harmony of color of the gingival tissue. After two years, small areas of repigmentation were identified, but not interfering with the aesthetic outcome of treatment. The proposed technique was effective in removing the melanin pigment, resulting in a satisfactory aesthetic.

Zinc, vitamin A, and glutamine supplementation in Brazilian shantytown children at risk for diarrhea results in sex-specific improvements in verbal learning

OBJECTIVE: To identify the impact of supplemental zinc, vitamin A, and glutamine, alone or in combination, on long-term cognitive outcomes among Brazilian shantytown children with low median height-for-age z-scores. METHODS: A randomized, double-blind, placebo-controlled trial was conducted in children aged three months to nine years old from the urban shanty compound community of Fortaleza, Brazil. Demographic and anthropometric information was assessed. The random treatment groups available for cognitive testing (total of 167 children) were: (1) placebo, n = 25; (2) glutamine, n = 23; (3) zinc, n = 18; (4) vitamin A, n = 19; (5) glutamine+zinc, n = 20; (6) glutamine+vitamin A, n = 21; (7) zinc+vitamin A, n = 23; and (8) glutamine+zinc+vitamin A, n = 18. Neuropsychological tests were administered for the cognitive domains of non-verbal intelligence and abstraction, psychomotor speed, verbal memory and recall ability, and semantic and phonetic verbal fluency. Statistical analyses were performed using SPSS, version 16.0. ClinicalTrials.gov: NCT00133406. RESULTS: Girls receiving a combination of glutamine, zinc, and vitamin A had higher mean age-adjusted verbal learning scores than girls receiving only placebo (9.5 versus 6.4, p = 0.007) and girls receiving zinc+vitamin A (9.5 versus 6.5, p = 0.006). Similar group differences were not found between male study children. CONCLUSIONS: The findings suggest that combination therapy offers a sex-specific advantage on tests of verbal learning, similar to that seen among female patients following traumatic brain injury.

Tourette's syndrome: from demonic possession and psychoanalysis to the discovery of gene / Síndrome de Tourette: da possessão demoníaca e da psicanálise à descoberta dos genes

In this paper we make a brief historical review of the hypothesis concerning the etiology of Tourette's syndrome (TS), focusing on varying trends over time: at first, its presumed relation to witchcraft and demonic possessions, followed by the psychoanalytical theory, which attributed TS to a masturbatory equivalent. Then, progressing to modern time, to the immunological theory and finally the advent of genetics and their role in the etiology of TS.

Os autores fazem uma breve revisão histórica enfatizando alguns importantes fatores relacionados com a síndrome de Tourette (ST) através dos tempos. Primeiramente, a relação da síndrome com possessões demoníacas, bruxaria; depois, a hipótese psicanalítica, que considerava os tiques como um equivalente masturbatório. Na sequência, discute-se a hipótese imunológica; depois, revisa-se a hipótese imunológica; finalmente, o papel dos genes na etiologia da ST.

Protease inhibitor and metabolic alteration / Inhibidor de la proteasa y alteraciones metabólicas

Protease inhibitors (PIs), part of HAART (Highly Active Antiretroviral Therap) are selective, competitive inhibitors of protease, a crucial enzyme to viral maturation, infection and replication. A lipodystrophic syndrome has been reported in individuals treated with HAART, and associated to hyperglycemia, hypercholesterolemia, hypertrigliceridemia, hyperlipidemia, hypertension and hypreinsulinemia. The HAART-associated metabolic abnormalities were first associated with protease inhibitors, Ritonavir mostly, but the mechamisns that underlie these metabolic alterations are to date, not completely understood. Since PIs are candidate to be the drug of choice for other diseases treatment, such as the Hepatitis C, malaria and some types of cancer, it seems to be important to clarify the metabolic alterations associated to PIs. Wistar rats were treated twice a week with 30mg/kg Ritonavir for 4 and 8 weeks. Total cholesterol, HDL, LDL, VLDL, triglycerides and glycemic levels were measured by the end of each period of time selected. To avoid confunding effects of food intake, the animals were fasted 16 hours before. Our results showed rapid increase in serum triglycerides, total cholesterol, LDL-C and glycemic levels. No significant differences were observed for HDL-C or VLDL serum levels. Our study addresses the importance to observe the possible family history of dyslipidemia or diabetes, and control any other cardiovascular and diabetes risk factors when using protease inhibitors.

Los inhibidores de la proteasa (IP), que forman parte de la terapia HAART (terapia antirretroviral altamente activa), son inhibidores selectivos y competitivos de la proteasa, enzima crucial para la maduración, infección y replicación viral. Un síndrome lipodistrófico, asociado a hiperglucemia, hipercolesterolemia, hipertrigliceridemia, hiperlipidemia, hipertensión e hiperinsulinemia, ha sido relatado en pacientes tratados con HAART. Las anomalías metabólicas asociadas a la HAART fueron relacionadas, inicialmente, a los inhibidores de la proteasa, principalmente el Ritonavir, pero los mecanismos que relacionados a estas alteraciones metabólicas son poco comprendidos. Dado que los IP son posibles candidatos a fármacos de elección para tratamiento de otras enfermedades, como hepatitis C, malaria y algunos tipos de cáncer, es importante esclarecer las alteraciones metabólicas asociadas a los inhibidores de la proteasa. Ratas Wistar fueron tratadas dos veces por semana con 30 mg/kg de Ritonavir por 4 y 8 semanas. Fueron determinados los niveles de colesterol total, HDL, LDL, VLDL, triglicéridos y glucemia, al final de cada período considerado. Para evitar la interferencia de la ingestión de alimentos en las determinaciones de laboratorio, los animales fueron sometidos a un ayuno previo de 16 horas. Nuestros resultados mostraron un rápido aumento sérico de los niveles de triglicéridos, colesterol total, LDL-C y glucemia. No se observaron diferencias significativas para los niveles séricos de HDL-C o VLDL. Nuestro estudio apunta a la importancia de considerar los posibles antecedentes familiares de dislipidemia o diabetes, y controlar cualquier otro factor de riesgo cardiovascular y de diabetes cuando se utilizan los inhibidores de la proteasa.

Diarreia associada a Shigella em crianças e sensibilidade a antimicrobianos / Diarrhea associated with Shigella in children and susceptibility to antimicrobials

OBJETIVO: Avaliar a distribuição e suscetibilidade a antimicrobianos de Shigella isolada de crianças com diarreia aguda e sem diarreia em Teresina (PI). MÉTODOS: Quatrocentas crianças com idade até 60 meses foram estudadas. Fezes foram coletadas de todos os pacientes entre janeiro de 2004 e agosto de 2007. Shigella foi identificada por métodos convencionais e antibiograma e pesquisa de β-lactamase de espectro ampliado (ESBL) foram realizados por difusão em ágar. RESULTADOS: Shigelose foi detectada apenas em crianças com diarreia aguda (26/250; 10,4%), especialmente naquelas entre 6 e 24 meses de idade e nos meses chuvosos. Shigella foi suscetível a ceftriaxona, ciprofloxacina e ácido nalidíxico. Mais da metade das amostras foram resistentes a sulfametoxazol-trimetoprim e ampicilina. ESBL não foi detectada. CONCLUSÕES: S. flexneri é comum em Teresina. A resistência a ampicilina e sulfametoxazol-trimetoprim é preocupante, pois estas drogas são amplamente utilizadas na prática e sulfametoxazol-trimetoprim ainda é recomendada para tratamento de crianças com suspeita de shigelose.

OBJECTIVE: To evaluate the distribution and susceptibility to antimicrobials of Shigella isolated from children with acute diarrhea and without diarrhea in Teresina, state of Piauí, Brazil. METHODS: Four hundred children aged up to 60 months were studied. Stools were collected from all the patients between January 2004 and August 2007. Shigella was identified by conventional methods and antibiogram and extended-spectrum β-lactamase (ESBL) were performed by agar diffusion. RESULTS: Shigellosis was only detected in children with acute diarrhea (26/250; 10.4%), especially in those aged from 6 to 24 months and in the rainy months. Shigella was susceptible to ceftriaxone, ciprofloxacin and nalidixic acid. More than half of the strains were resistant to sulphametoxazole-trimethoprim and ampicillin. ESBL was not detected. CONCLUSIONS: S. flexneri is common in Teresina. The resistance to ampicillin and sulphametoxazole-trimethoprim gives cause for concern, as these drugs are widely used in practice and sulphametoxazole-trimethoprim is also recommended for treating children suspected of having shigellosis.